Page 1 of 2: A 54-year-old woman sustained an anterior wall myocardial infarction

dinaridi · Credits: 2860 My Scrapbook

A 54-year-old woman sustained an anterior wall myocardial infarction complicated by pulmonary edema. She is symptomless at discharge from hospital 7 days later. Which one of the following treatments is INAPPROPRIATE?
1) propranolol
2) captopril
3) acetylsalicylic acid
4) diltiazem
5) isosorbide dinitrate

met5 · Credits: 3061 My Scrapbook

4) diltiazem

kangaroos · Credits: 253 My Scrapbook

i think it's 5) Isosorbide dinitrate because doesnt that have to be constantly monitored? i'm not sure, can someone help.

adrian · Credits: 3214 My Scrapbook

4).You don't need myocardial deprssion in this setting.CCBs are not given in cases of ventricular muscle dysfunction.

met5 · Credits: 3061 My Scrapbook

actually i think you're right, it's 5, for reasons i can'T explain

adrian · Credits: 3214 My Scrapbook

No,met5.You were initially right.

met5 · Credits: 3061 My Scrapbook

i don't think so. Both 4 and 5 are CCB but diltiazem has similar effects as BB and can be used in CAD, not the case for nitrosorbide.

adrian · Credits: 3214 My Scrapbook

I was referring to non-dihydropyridine CCBs(vera,dilti) which are contraindicated in a setting with ventricular impairment(as anterior MI).Furthermore, myocardial dysfunction was severe enough to produce pulmonary edema and the depressant side-effects of a non-dihydro CCB(hypotension,brady,block) can seriously jeopardize his present (stable) status.On the other hand ISDN is a nitroderivate and not a CCB;nitrates act directly on vascular smooth muscle producing vasodilatation,hence increasing myocardial O2 supply,which is beneficial in this patient(it's well accepted that vasodilators -nitrates and hydralazine- have positive effects in CHF,which the patient fortunately survived).Hope that helps a bit...

maryana · Credits: 15476 My Scrapbook

Dultiazem

bloater · Credits: 1258 My Scrapbook

Why don't say about the negative inotropic effect of Propranolol ?
Its merit might be overestimated in terms of coronary protective effect.
This patient is in heart failure. And medications influencing inotropic negativity must be reviewd on the same ground.

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